So much water has passed under the bridge since I last wrote; Wimbledon, the Olympics,  Euro 2004 (and yes I do regret the snidely remarks I made in my last article about our footballers being tired!).

I have had an increasing number of emails from injured readers – most of which are printable, (Alan from Burnley, thanks for the offer but I am busy for the next 20 years!).  But please feel free to carry on with the questions – I try to answer them all but can’t guarantee I’ll be of any help!

I am getting a number of emails from junior players which has started to alarm me.  My article in January’s issue has sparked a forest fire of reports of ill health – the majority of which are limb injuries in the under 18s.  I fear something must be done – especially if we are going to build on our recent success as a badminton playing nation.

To set about this task I did some soul searching – after all, I was a teenager once too.  Sadly, all I can remember are brief snapshots of my teenage life (Duran Duran, the beautiful Clare Webster, Glandular Fever and Acne) so I thought I’d make some enquiries and question the poor injured juniors that have been filling my ‘Inbox’ for the last few months.

Regrettably, some of the juniors I spoke to had developmental anomalies and there are two common pathologies in ‘athletic’ teenagers, both of which affect the knees.  The first is Osteochondromalacia Patellae which presents itself  underneath the surface of the Patella (knee cap).  The X-Ray images show a roughening of the inferior surface.  This roughening interferes with the tracking of the patella apparatus and causes pain and inflammation of the knee.  Osteochondromalacia Patellae has a higher incidence in female teenagers.

The second pathology, standing boldly in the male teenage corner, is the wonderfully named Osgood-Schlatter’s Disease.  This develops when the quadriceps tendon seemingly over-pulls on it’s insertion which is situated just below the knee.  This traction forces the body to lay down more bone and the sufferer reports pain (from the associated tendonitis) and bony prominence (knobbly knees).

The cause of these conditions is unknown, however, posture, genetics and over activity are widely cited as being contributing factors.  Sadly, badminton is the type of sport that places a great deal of strain on the knees and therefore Osgood-Schlatter’s and Osteochondromalacia end future playing careers prematurely.  Sadder still, there is no known treatment for the conditions.  There are many therapies that reportedly treat the symptoms but nothing substantial has been studied.  My advice would be to treat the ‘active’ phases as you would another sporting injury – rest, ice, compression, elevation, re-hydration and proper rehabilitation.

Thankfully, nearly all of the juniors I spoke to reported ‘minor’ injuries of tendons, muscles and, occasionally, joints.  These injuries are directly related to not warming up correctly, bad posture, poor diet/dehydration, bad playing habits (i.e. poor technique) or ill fitting/poor use of equipment.  In the few that have seemingly good badminton career prospects there was evidence that they were overtraining which is number one in the ‘coaching manual’ sin list!

On this rather dull note I will sign off for another issue, leaving me wondering still what the delicious Clare Webster might be up to!!!!

JH

Season 2003/2004 draws to a close and all the fun of late night matches in tiny one-court village halls is replaced by a few hours of gardening a week and the occasional walk along Bridlington seafront.

Those of us lucky enough to be injury free at the end of the season might, at this very moment, be planning summer activities to fill the badminton void but the less fortunate, injured souls have got nothing to look forward to – unless you count the excitement of Euro 2004 that is!  But don’t waste time taking pity on yourselves because you’ve got to feel sorry for those footballers, haven’t you?  They must play at least 6 games a month, plus training, then there are the endless photo shoots and marketing opportunities – not to mention the regular trips to ‘Ferrari World’ for the latest pininfarina number.  My heart bleeds; just as ‘Posh’ thinks she’ll have ‘Becks’ home for the summer, he jets off to Portugal for a few more games and a sledging from the press (I think that they should replace their names on the back of their shirts with the phrase ‘Red top cannon fodder’!)  So, when Gary Linekar smiles that smile and introduces the first match for your enjoyment, try not to moan at the players as they stand there miming to a national anthem they don’t know all the words to!  Feel sorry for them – they might be feeling a little tired.

In all honesty, squeezing a tournament into a few summer months is probably a bit taxing, physically.  Soon, as more and more sports turn professional, the perennial argument regarding the timetabling of extra-curricular competitions will reach such a point that something will have to be done.  Even at the bottom of the competition ladder (for example, the South East Worthing Regional Mixed Division VII) we tend to feel the physical strain put upon us by poorly timetabled league matches, tournaments and club nights.  How many times have you muttered obscenities towards the ‘Match Secretary’ for booking three matches between Christmas and New Year and leaving the next three weeks completely match free?

So, what if we are a bit tired?  What are the risks of a bit of ‘badminton burnout’?  The simple answer is the reason why ‘physical medicine’ was recently tipped as the boom industry for the new millennium – INJURY.  The very word that makes us mortal sports people shudder with fear whilst, simultaneously, causing the NHS budget for the next twelve months to flinch in preparation for the burden that it will be have to undertake.

Quite literally, take your pick – chose any joint in the body, any tendon, even a dreaded ligament and if it is prone to injury or has previously demonstrated weakness, the chances of a serious problem developing are extremely high.  The body needs time to heal, and a gruelling, uneven timetable of league matches juxtaposed with the odd club night and a trip to the gym could just be enough to transform a nagging, intermittently painful knee cartilage into a full-blown tear the renders it’s owner unable to walk down stairs or bend the knee any more than 75 degrees.

So, lets have a new season resolution – get the powers that be to schedule matches evenly and try and aim for, at least, one clear day between hard exercise.

JH

As the smell of overcooked sprouts fades (don’t ‘cross’ the ends in future!!) and the debt of the season hits home, I would like to wish you all an injury-free New Year.

I am enjoying the emails that you are sending and please accept my apologies if I have not got round to replying personally.  Next issue, I would like to look at elbow problems so if you have an interesting story I would like to hear from you.

Post Christmas, the issue that most mortals struggle with is a growing waistline.  Whilst I agree this is a pain – it is something that I cannot really help with.  The ‘Growing Pains’ header refers to another breed of badminton player – juniors.

Junior players are a threatened breed, although all clubs have them (or should).  Hardened ‘seniors’ look at their junior counterparts and sneer – juniors don’t wear predominantly white clothing, they know that Nintendo’s Mario has a brother (and can name him) and they assume that Captain Kirk has always been bald!  What’s more is that they are usually well taught, have limited ‘bad habits’ and can probably hold their own in senior clubs.  However, whilst we confine this endangered species to the glorified crèche that precedes the ‘proper’ sport I appeal to the parents, coaches and fellow club members to keep an eye on them.  The reason for this is two-fold.  Primarily, Badminton will die if we do not encourage our junior members (we should learn from the Tennis situation in the UK) but more importantly, they suffer injuries too, which if left undiagnosed, end promising careers.

If we are to believe the specialists, our children and teenagers are not a healthy bunch.  I would have to agree that the number of patients, under the age of eighteen that my practice consults has increased dramatically in the last ten years.  The stories of poor diet and obesity are well publicised and these poor souls should have been encouraged to live a more balanced lifestyle early on but it is the few junior ‘athletes’ that we must nurture.

When we are infants, our skeleton is comprised of a small amount of bone that grows, based on a pre-existing cartilaginous model.  Our structure is predetermined but we are not complete (think of the soft part of a new-born’s skull).  Consequently, our musculoskeletal system evolves with the activities that we choose.  Our form is stronger if we decide on an ‘active’ life and obviously weaker if we prefer playing computer games and eating fast foods.

The more athletic teenagers are, unfortunately, also at risk.  Not from heart disease or ‘Playstation Thumb’ but from what appear to be niggling injuries that are repeatedly misdiagnosed as ‘Growing Pains’.  The average female stops growing at the age of 18, whilst the male’s ETA is approximately 22 years. Until these points, we are not completely formed and subsequently suffer with some of the following musculoskeletal injuries: 

• Neck Pain
• Shoulder Pain and Stiffness
• Tennis/Golfers Elbow
• Wrist strain
• Low Back Pain
• Knee Tenderness
• Achilles Tendon strains

Those of us that have any connection with the Badminton stars of the future should act as mentors.  We should spend less time teaching them how to perform clever little disguised drop shots (or serving from the ‘tram lines’, (of which there is never an excuse for!)) and more time making sure they warm-up correctly, eat properly and regularly and drink fluids during matches (preferably at the change of ends).  Above all, listen!  If they are complaining of symptoms, you should seek help.

Think of these measures as investment – after all, they chose our nursing homes!

JH

In April’s edition I made a glib comment regarding knee pain.  Predictably, ever since my ‘inbox’ has been full of emails about nothing else! So, the time has come to tackle the most difficult of subjects – the knee, but before I start, please remember that you can email me should you wish to ask any ‘easier’ questions!!!

It seems simple, the knee; a nice big joint which is placed conveniently in the middle of our lower extremity.  It bends quite easily one way but not so easily the other.  There is a small amount of rotation both internally and externally and a healthy mix of cartilage and ligaments.  The icing on the proverbial cake is a complex group of powerful muscles, one of which even houses its own protective mechanism, (the patella or knee cap).  So, no problem then – we’ll move on shall we?  Obviously not, judging by the amount of knee braces and bandages we see on court there must be a problem.  But what could it be?  The answer, I’m afraid is very simple – vulnerability.  The main problem with the knee is its sheer size and the amount of work that it has to do.  From the moment we take our first steps to the very last verse of ‘Abide with me’ our knees are constantly being abused.  In addition to this, we start exercising – hopefully from a very young age, (depending on the latest release by Nintendo/Bill Gates).  As we increase our exercise levels, our muscles provide more stability, which is a positive thing.  Unfortunately, this is outweighed by the hugely negative increase in compression that the knees are subjected to and this can lead to one of the following:

Cartilage/Ligamentous damage

Osteoarthritis (‘wear and tear’)

Tendonitis

Changes to the structure and formation of bone

Bursitis

Those of you that are reading this article that are familiar with the above problems are busily looking for a panacea for knee pain and I am sorry to say that a wonder cure has not yet been found.  As with all musculoskeletal problems prevention is far better than cure and there are a few simple points that are always worth mentioning.

Wear appropriate footwear

Warm up/cool down properly

Schedule your exercise evenly

Consult appropriate professionals when injured

Use ‘cold compresses’ as a first aid measure (should you sustain an injury)

Most importantly, PAIN IS A ‘RED LIGHT’.  If you start noticing a problem with your knee then you must STOP immediately and certainly do not use pain killers prior to  or during sport.

The use of orthotics, knee supports and braces might help your plight but these should be fitted by a trained professional – you don’t ask the sales assistant in the motoring shop for advice about fixing your car and the same goes for the sales assistant in your local sports shop!

A final note – in contrast to popular belief, there is a name for the back of the knee.  It is referred to as the popliteal fossa and scores pretty highly on a ‘Scrabble’ board!

JH

Thank you for the responses to my last article.  I have tried to answer your emails personally but please accept my apologies if I didn’t get back to you.

Many of you asked where you can find your local osteopath.  The General Osteopathic Council can give you details of osteopaths in your area.  The GOsC can be telephoned on 020 7357 6655 or you can visit their website, (www.osteopathy.org.uk).

Mr James Heasman from Worthing contacted me regarding his ankle.  Some time ago, whilst on court, he had the misfortune of rupturing his Achilles tendon and enquired as to his next, best course of action with regard returning to competitive badminton matches now that the tendon has been surgically repaired.

Achilles was a Greek hero. He was the son of the Sun Goddess Thetis.  In his childhood he was dipped in the River Styx by his mother to make him invulnerable, except for the heel by which she held him. This gave rise to the term ‘heel of Achilles’ which can be any point of weakness.  Achilles died when leading the Greeks to the storming of Troy. He was shot by an arrow which struck his vulnerable heel and killed him…………..so, now you know!

The Achilles tendon remains a vulnerable point in ALL of us.  Ironically, Mr Heasman’s surgically repaired tendon is probably stronger now than it ever was; however, the following advice is relevant to us all.

The tendon is a dense, muscular structure that needs to be looked after.  It needs to be ‘warmed up’ by simple stretching before each game is played.  If the Achilles tendon shows signs of trouble, (e.g. pain on movement, swelling or increased redness or bruising), it needs to be rested IMMEDIATELY and simple ‘first aid’ measures (such as the application of a cold compress) need to be performed.

Almost as important as the ‘preparation’ of the Achilles tendon is the choice of footwear that we compete in.  A Formula 1 car needs top class contact with the tarmac to win races and you do to.  Mr Schumacher et al don’t pop to the local Kwik-Fit for a cheap set of ‘remoulds’ on their way to Monaco and, similarly, you should not play in the shoes that you wore during a tennis match last week!

Badminton shoes are designed for the purpose – the clue is in the title!  They are lighter, have narrower soles and provide good ‘transitional’ grip.  Other shoes are just the opposite.  If you wear a heavier shoe, with a wider sole, your ‘turning circle’ will be comparable to an oil tanker and any attempt to challenge this might lead to a visit to your local surgeon for an operation similar to Mr Heasman’s.  And, don’t get me started on the knee!  Improper footwear and knee injuries go together better than ‘Richard & Judy’, but the after-effects are far more unpleasant.

My final point returns, once again, to preparation.  Badminton is an indoor game.  Badminton shoes are for indoor use only.   If you wear the shoes you play in outside you get the soles dirty (not to mention the court).  The sole of a badminton shoe is designed to be kept clean for maximum grip.  If the soles are full of dirt and dust (or grass!) then you will be playing badminton whilst wearing a light, slippery soled shoe and, to be perfectly honest, you might as well try and play in ice skates!

Thankfully, badminton shoes are inexpensive – and there is something very ‘professional’ about arriving courtside and changing your footwear.  The impression it gives will earn you the first five points as your opponents will think that you are a professional/Emmelda Marcos/have read this article (delete as appropriate).

You have been warned!

JH

We have all done it at some point….meeting runs late, quick sandwich in the car on the way to a tiny village just outside Maidstone (with an even smaller village hall!).  Change into sports clothes in the back of the car and burst through the creaky wooden door to aforementioned hall to find your doubles partner signalling your lateness by tapping their watch in between ‘knocking-up’ on court.  Not bad, really – only ten minutes late, grab your racket from the bag, few practice serves and ‘love all’.  Sounds familiar?  The details might be slightly different but the end result is the same.

So, as you move gracefully to execute your first devastating ‘smash’, what will your body be doing?  Struggling!  Your heart rate will be fine; the pressured journey from work to court would have released enough adrenalin to see to that.  The main struggle will be with the increased activity that your body has now been asked to undertake.

Suddenly, all the major muscle groups of the body have been asked to spring into action.  Your thigh muscles suddenly need more blood than they have had all day and your upper body needs, not only the strength, control and power to strike the shuttle, but also the guidance and balancing properties of the inactive arm.

Inevitably, your first few ‘glory’ shots hit the net, or worse, your partner.  That is if you are lucky!  The majority of badminton players that I consult professionally are injured and when questioned regarding their pre-game preparation almost all of them report that they spend a few minutes knocking-up before a game.  My response is always the same: ‘knocking-up is not warming-up!’

If I was perfectly honest, the majority of the injured players that I see could have prevented their ‘minor’ injuries by warming-up properly and this starts as early as the morning before the game.  We should take light meals at regular intervals and drink plenty of water (avoiding tea, coffee and alcohol which are diuretics).  Well fuelled, hydrated cells perform much better than dehydrated ones.  We should manage our diaries so that we can be at the match venue at least twenty minutes before the match begins.  This time should be spent performing simple stretches, especially concentrating on the arms, chest, lower back, thighs and calves.  Stretching helps increase the blood flow and ‘drainage’ of muscles and prepares the fibres by elongating them.

We are now able to play some practice shots before the game commences.  This should be a structured routine of short play, clears and overhead shots, not a quick ‘knock’ whilst discussing Eastenders!  When the game starts you can rely on the fact that your musculoskeletal system is well prepared for the task in hand. With any luck, your first ‘smash’ will be a turning point in the game and your partner will not have any scars to show for their labours.

In future issues of ‘Badminton’ I would like to answer any questions that you might have.  Please feel free to email me and I will endeavour to answer as many as I can in next month’s edition.

JH